Provider Demographics
NPI:1669086765
Name:GREEN, TRINA SHERRINE
Entity type:Individual
Prefix:
First Name:TRINA
Middle Name:SHERRINE
Last Name:GREEN
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:TRINA
Other - Middle Name:SHERRENE
Other - Last Name:GREEN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:17304 NE 114TH AVE
Mailing Address - Street 2:
Mailing Address - City:WALDO
Mailing Address - State:FL
Mailing Address - Zip Code:32694-4220
Mailing Address - Country:US
Mailing Address - Phone:352-514-8535
Mailing Address - Fax:
Practice Address - Street 1:17304 NE 114TH AVE
Practice Address - Street 2:
Practice Address - City:WALDO
Practice Address - State:FL
Practice Address - Zip Code:32694-4220
Practice Address - Country:US
Practice Address - Phone:352-514-8535
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-04
Last Update Date:2020-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372600000XNursing Service Related ProvidersAdult Companion